Provider Demographics
NPI:1265101752
Name:BREWER, DEBORAH (CTRS)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1053
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-1053
Mailing Address - Country:US
Mailing Address - Phone:616-215-0444
Mailing Address - Fax:
Practice Address - Street 1:4934 LUXEMBURG ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8406
Practice Address - Country:US
Practice Address - Phone:616-215-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23191225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist